American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

From the Director’s Desk

Addressing COVID-19’s Impact on Cancer Care and Screening with New PDSA Project

Heidi Nelson, MD, FACS

Heidi Nelson, MD, FACS
Medical Director, ACS Cancer Programs

By now most of you have seen the Return to Screening Plan/Do/Study/Act (PDSA) Quality Improvement and Clinical Study Project that was distributed in the April 8 edition of Cancer Programs News and posted on the American College of Surgeons (ACS) Cancer Programs website at Project and Clinical Study Details. The project emerged spontaneously out of a committee meeting conversation about the negative impact that the COVID-19 pandemic is having on cancer care and screening. The forecast for patients at risk of getting cancer does not look good unless we act now to reverse the below average trends in screening. To address this critical gap, we assembled a rapid response team across the Commission on Cancer (CoC), American Cancer Society, and National Accreditation Program for Breast Centers (NAPBC) to draft and distribute a quality improvement and clinical study that programs can use to restore screening to pre-pandemic levels.

We are pleased that so many of you have expressed interest in participating in the project. For those of you who might be considering participating, it is not too late to get involved. You have until May 31, 2021, to review the project details, select the screening disease site (breast, colorectal, lung, or cervix), establish your screening rate target goal, and choose one or more of the listed interventions. Given all the disruptions we have experienced in our lives, work, and health care, we made the decision to grant multiple credits for CoC and NAPBC standards. You can receive up to three total credits if you participate in the screening interventions (CoC 8.3 or NAPBC 4.1) and the PDSA quality improvement (CoC 7.3 or NAPBC 6.1) and the clinical study (CoC 9.1 or NAPBC 3.2).

We realize that we are modifying the rules for some of the standards, and this choice generates questions. So, we are continually updating the FAQ document that is currently posted in the Standards Resource Library within CoC Datalinks for CoC Programs and in the Resources section of the Quality Portal for NAPBC programs. Please bear in mind that exceptions to the rules apply only in 2021 and only apply to the return to screening PDSA and clinical study project. Lastly, we realize that you may have to modify your routine screening protocols due to safety concerns or other novel COVID-19 considerations, such as the interactions between vaccinations and mammography, as reported by the Society of Breast Imaging.

Register Today for the ACS Cancer Programs Conference VIRTUAL: Quality Care in Motion

The 2021 ACS Cancer Programs Conference VIRTUAL: Quality Cancer Care in Motion is a few days away. Make sure to join us on the morning of April 28 for two important sessions on the operative standards, Fulfilling the Operative Standards and Synoptic Reporting and Fulfilling the Operative Standards and Pathology Reporting.

Beginning at 9:00 am CT, listen to a panel on Fulfilling the Operative Standards and Synoptic Reporting made up of Mediget Teshome, MD, FACS, Chair, Cancer Surgery Standards Program (CSSP) Education Committee; Timothy Vreeland, MD, FACS, Vice-Chair, CSSP Education Committee; and Arden Morris, MD, FACS, Chair, CSSP Implementation and Integration Committee. The panel will discuss the requirements for Standards 5.3 through 5.6, including synoptic content of the operative reports as well as implementation strategies and the implementation time lines.

Immediately following, at 10:00 am CT, is the Fulfilling Operative Standards and Pathology Reporting panel lead by Matthew Katz, MD, FACS, Chair, CSSP with Thomas Baker, MD, FCAP, Vice-Chair, American Joint Committee on Cancer (AJCC) Education Committee. Tune in to hear Dr. Katz discuss the requirements for Standards 5.7 and 5.8 and Dr. Baker discuss the link between the surgeon and the pathologist for the success of these standards.

Register today for this virtual conference to learn more about the ever-evolving science of cancer care. Conference participants can earn 13.25 CME credits, 13.25 CNE credits, or 13 NCRA-approved CE credits.

While you are attending the conference, don’t forget to visit the virtual booths for our exhibitors:

  • ACS Continuous Quality Improvement
  • ACS Cancer Programs
  • ACS Committee on Trauma
  • ACS Member Services
  • Oncolens

Exhibits sponsored by ACS programs are a great opportunity to learn more about all of the College’s accreditation programs and gain specific information about the cancer accreditation programs, the work of the Committee on Trauma and the trauma certification programs, as well as services and resources for ACS members offered through the ACS Division of Member Services.

Make sure to visit the virtual booth sponsored by Oncolens to learn about their services related to tumor board management, survivorship care planning, accreditation, and quality improvement.

NCI Grant to Support Research on Improving Quality of Rural Cancer Care

Mary Charlton, PhD, has been awarded a grant from the National Cancer Institute (NCI), part of the National Institutes of Health, as principal investigator for research that focuses on a collaborative network intervention to improve cancer care quality in rural hospitals caring for rural, underserved patients. Commission on Cancer Chair Timothy Mullett, MD, FACS; CoC Iowa State Chair Ingrid Lizarraga, MBBS, FACS; and Sarah Birken, PhD will serve as co-investigators on the grant, entitled “Effectiveness and implementation of a health system intervention to improve quality of cancer care for rural, underserved patients.”

“The best possible outcome from this grant would be to improve the quality of cancer care in rural areas. This will be done through the establishment of an evidence-based path to sharing resources between rural and urban cancer programs that will make achieving CoC standards more feasible for smaller hospitals,” said Dr. Charlton.

There is growing evidence that limited access to high-quality cancer treatment is one of the main drivers of higher cancer mortality rates among rural cancer patients. The team’s analyses of Iowa Cancer Registry data indicates that 40 percent of rural patients with breast and colorectal cancers receive most or all definitive treatment in rural hospitals that do not collect or monitor data on their quality of cancer care and are far less likely to be CoC accredited, a marker of high-quality care. In addition, the data shows these patients are less likely to receive guideline-concordant care. Given patients’ needs and preferences to receive cancer care locally, a promising strategy to improve quality of cancer care and outcomes in rural populations is to intervene directly with the community hospitals in these areas.

Following the successful approach of the Markey Cancer Center Affiliate Network (MCCAN) of the University of Kentucky Markey Cancer Center, Dr. Charlton and her co-investigators are working toward establishing the Iowa Cancer Affiliate Network (I-CAN). They have identified four rural Iowa community hospitals to participate in this intervention trial and developed expert support teams to assist key stakeholder groups within each hospital. They will assess determinants and outcomes of the implementation process, along with stakeholders’ perception of the value and utility of the CoC accreditation standards and the intervention itself as a way to improve the quality of cancer care for their patients.

This work could lead to dissemination of similar models across rural settings, thereby improving quality of care, reducing rural disparities in cancer outcomes, and giving rural hospitals an avenue to demonstrate their quality of care.

“This study represents the first NCI-funded project to apply state-of-the-science methods of adapting an evidence-based intervention to promote its implementation and effectiveness in a new context, “ said Dr. Birken. “In so doing, the study not only extends the demonstrated benefits of MCCAN to Iowa cancer programs, it also advances these emergent implementation science methods with empirical data.”

New Research Reveals Potential Ways to Improve Survival for Certain Cancer Patients Who Receive Fragmented Care

New research reveals that 28 percent of patients who are readmitted to the hospital with complications after surgical removal of pancreatic, liver, or stomach cancer go to a different hospital for follow-up care. This fragmentation of health care is associated with a 50 percent increased odds of dying, according to a study published online by the Journal of the American College of Surgeons ahead of print.

The researchers from Washington University School of Medicine, St. Louis, sought to identify patient and hospital characteristics that raise the death risk during readmission to an outside hospital—one other than the original hospital where the operation was performed, referred to as the index hospital. Using the state inpatient databases from the federal Healthcare Cost and Utilization Project, the investigators evaluated data from adults undergoing surgical removal of liver, pancreatic, bile duct, and gastric cancers beginning in 2006. Patients lived in California, Florida, or New York.